The study objectives were:
1. To estimate the rate of willingness to receive COVID-19 vaccination among the general population in Saudi Arabia as of June 2021.
2. To explore factors associated with acceptance of COVID-19 vaccination.
3. To examine the association between social media use and acceptance of COVID-19 vaccination among the general population in Saudi Arabia.
Study design and data collection
This cross-sectional analytic study used data from a survey that was conducted on the acceptability of (willingness to receive) COVID-19 vaccination among the general population in Saudi Arabia from June 17 to June 19, 2021.
The survey was constructed by the investigators after reviewing the relevant literature. Most of the questions were adopted from previous surveys of similar studies: one study on the acceptability of COVID-19 vaccination  and a second one that assessed COVID-19-related fake news on social media . Both sources had open permission to reproduce the research material [1, 29]. The questions were then reviewed independently by two consultants (SO and RG). The survey questions were originally in English. AS, RB, GS and RO translated the questions into Arabic, and RA and RH translated them back to English to ensure that the translation was accurate and preserved the meaning of each question. The survey included questions on demographic data, medical and vaccination history, pattern of social media use, willingness to be vaccinated and reasons for refusal (if applicable). The survey was then distributed to the general population online (in both English and Arabic), using Google Forms through various social media platforms. An online approach was used to avoid physical contact during the pandemic.
As the COVID-19 vaccine was approved by the Ministry of Health during the study period for administration to adults [30,31,32], our target population was adults 18 years or older who live in Saudi Arabia. Exclusion criteria were individuals less than 18 years old, and those who have a contraindication to receiving COVID-19 vaccination (e.g., allergy to vaccine components).
Prior to the beginning of the survey, online informed consent was obtained from the participants. This included clear information about the study objectives and the target population (eligibility to participate). Participants were clearly informed that the answers they provided would be anonymous and confidential. The informed consent provided two options: ‘yes’ for those who agreed to volunteer and participate in the study and ‘no’ for those who did not wish to participate. Only those who consented and selected ‘yes’ were taken to the questionnaire page to complete the survey.
The sample size was calculated by using the single proportion equation in the Raosoft software package. Based on the assumption that the rate of COVID-19 vaccine acceptance is 50%, and a margin of error of 5% at the 95% confidence level, the required sample size was 385. We collected responses from 504 participants. The snowball sampling technique was employed, and the survey was distributed online to avoid physical contact during the pandemic.
The primary outcome variable for this study was acceptance of receiving COVID-19 vaccination. Acceptance was measured by response to the following survey question: ‘Are you willing to take the COVID-19 vaccine?’. Acceptance was defined by indicating ‘yes’ for the question, or by selecting the answer ‘I have already taken the vaccine’. Respondents who responded with ‘no’, i.e., they were unwilling to be vaccinated, were further asked to indicate the main reason(s) for their unwillingness to receive vaccination. The options were: fear of side effects, the vaccine has not been not tested long enough, the vaccine is not effective, and other/ personal reasons.
Other information obtained from the survey was collected as categorical data. First, sociodemographic characteristics were obtained, such as age, gender, marital status, the region of residency, monthly income, education level, and whether the respondent was working in the ‘front line’ in terms of potential exposure to COVID-19. Front-line healthcare workers include all those who are the first contact with patients, such as paramedics, emergency department physicians and nurses, Family physicians, and those who work in COVID-19 swab centers, as well as those who look after COVID-19 inpatients and intensive-care units (ICU). The highest level of education refers to the highest degree obtained by the participant (categorized as Master’s or Doctor of Philosophy (PhD) degree, Bachelor, college diploma, high school certificate, and less than high school). Furthermore, participants were asked to indicate whether they have a degree in healthcare. This refers to graduates of the healthcare programs available in Saudi Arabia; physicians, dentists, nurses, paramedics, pharmacists, laboratory technicians, radiology technicians and physiotherapist. Monthly income in Saudi Riyals (SR) was also categorized into four categories: Less than SR 4000, between SR 4000—SR 10,000, between SR 10,000- SR 20,000, and more than SR 20,000.
In addition to sociodemographic data, information on medical and vaccination history was obtained. This included the presence of any chronic conditions (such as diabetes, hypertension, heart conditions, renal failure, and bronchial asthma), which was a binary variable with a ‘yes’ and ‘no’ options. Vaccination history was composed of previous refusal of vaccines and receipt of influenza vaccine in the past.
Other questions collected information about past infection and perceived risk of getting infected with COVID-19. In addition, participants were asked to indicate which side effects they think are expected after receiving COVID-19 vaccine. They were given the option to choose one or more of the following: Infertility, thrombosis, sudden death, genetic alteration or others.
Finally, information on patterns of social media use was collected, including the use of social media for COVID-19-related news and updates and the preferred social media platform.
Statistical analysis was conducted using IBM SPSS version 20.0 software. Descriptive statistics were presented as frequencies and percentages for the whole sample, and for the two groups of our primary outcome – those acceptant of COVID-19 vaccination and those who were not. The two groups were compared using chi-square test.
The association of each predictor with the outcome (‘acceptance’ vs ‘non-acceptance’ of COVID-19 vaccination) was further tested by conducting univariate binomial regression for each variable. The predictor variables that showed a significant association (p < 0.05) with the outcome in the univariate analyses and those with a near significant association (p < 0.1) were entered into a multivariable binary logistic regression model. The level p < 0.05 was used as the cut-off value for significance.
This study was designed and conducted in compliance with the ethical principles established by the National Committee of Bio and Medical Ethics at King Abdulaziz City for Science and Technology. Ethical approval was obtained from the Biomedical Research Ethics Committee, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia on June 14, 2021 (Reference number 334–21).